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Impacts of Pharmaceutical Marketing on Healthcare Services in the District of Columbia

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Impacts of Pharmaceutical Marketing on Healthcare Services in the District of Columbia Impacts of Pharmaceutical Marketing on Healthcare Services in the District of Columbia Prepared by The George Washington University School of Public Health and Health Services Washington, DC for the District of Columbia Department of Health June 15, 2009 TABLE OF CONTENTS I. EXECUTIVE SUMMARY......................................................................................................................................3 HEALTHCARE IN THE DISTRICT OF COLUMBIA...........................................................................................................3 FINDINGS ON PHARMACEUTICAL MARKETING IN THE DISTRICT................................................................................4 RECOMMENDATIONS .................................................................................................................................................6 II. THE ROLE OF PHARMACEUTICALS IN HEALTHCARE ..........................................................................7 PHARMACEUTICALS AND HEALTHCARE IN THE DISTRICT OF COLUMBIA...................................................................8 III. CONCERNS ABOUT PHARMACEUTICAL MARKETING.......................................................................13 PRESCRIPTION-DRUG EXPENDITURES ......................................................................................................................13 EFFECTIVENESS AND SIDE EFFECTS.........................................................................................................................14 OFF-LABEL PRESCRIBING........................................................................................................................................15 IV. EFFECTS OF MARKETING............................................................................................................................18 MARKETING TO PHYSICIANS ...................................................................................................................................18 Free Samples......................................................................................................................................................20 Research Participation and Results ...................................................................................................................20 Physicians in the District ...................................................................................................................................21 DIRECT-TO-CONSUMER ADVERTISING ....................................................................................................................22 Direct-to-Consumer Advertising in the District.................................................................................................24 FUNDING OF ORGANIZATIONS PRODUCING CONTINUING MEDICAL EDUCATION AND PATIENT INFORMATION .......24 Funding of Organizations in the District ...........................................................................................................26 V. EFFORTS TO CONTROL PHARMACEUTICAL MARKETING’S INFLUENCE....................................28 STATE-LEVEL EFFORTS............................................................................................................................................28 Minnesota...........................................................................................................................................................28 Vermont..............................................................................................................................................................29 District of Columbia...........................................................................................................................................30 Massachusetts ....................................................................................................................................................30 Other states ........................................................................................................................................................30 HOSPITALS AND MEDICAL SCHOOLS .......................................................................................................................31 District Hospitals and Medical Schools.............................................................................................................32 VI. RECOMMENDATIONS....................................................................................................................................35 RESEARCH OPTIONS AND LIMITATIONS...................................................................................................................35 STRENGTHENING ACCESSRX ...................................................................................................................................36 EDUCATING PRESCRIBERS .......................................................................................................................................37 FOCUSING ON TOP EXPENDITURE CATEGORIES .......................................................................................................37 VII. CONCLUSION ..................................................................................................................................................39 2 I. Executive Summary Prescription drugs represent a positive and high-value contribution to healthcare, but rapid growth in prescription-drug spending presents insurers, public programs, and individual patients with difficult choices about allocating limited healthcare dollars. Pharmaceutical marketing practices may encourage the use of new, expensive drugs when other alternatives may be safer, more effective, and more cost-effective. Of particular concern are cases in which pharmaceutical sales representatives attempt to downplay reports of serious side effects and encourage off-label prescribing that is not supported by strong scientific evidence or by FDA approval. Pharmaceutical companies have many marketing methods, which include detailer visits with prescribers; distribution of gifts and free samples; hiring of medical professionals to speak or consult on behalf of their products; direct-to-consumer advertising; and funding of organizations that provide continuing medical education, practice guidelines, and patient information. Medical and public-health experts have raised concerns about how all of these practices may influence prescribers and patients to prefer brand-name drugs even when they do not compare favorably to other alternatives in terms of costs, effectiveness, or risks. Several states and the District of Columbia now require that pharmaceutical manufacturers report their marketing expenditures, including gifts to prescribers, and Vermont and Massachusetts are acting to ban several types of gifts from pharmaceutical companies to healthcare providers. Several medical schools and hospitals have developed policies that limit the contact drug reps may have with providers, faculty, and students and that require disclosure of relationships that doctors, researchers, and faculty members have with pharmaceutical companies. This report investigates the ways that these trends affect the cost, utilization, and delivery of health care services in the District of Columbia. Information in this report about pharmaceutical manufacturers’ marketing expenditures in the District comes from pharmaceutical company reports, which the George Washington University School of Public Health and Health Services analyzed for the District of Columbia Department of Health. Many of the District-specific marketing figures mentioned in this report are described in greater detail in the report “Pharmaceutical Marketing Expenditures in the District of Columbia, 2007,” which was prepared by the George Washington University School of Public Health and Health Services for the District of Columbia Department of Health. Healthcare in the District of Columbia The District has a relatively low rate of uninsurance, which is due in large part to its generous public programs, but insurance does not necessarily mean adequate access to healthcare. Wide health disparities based on race and ethnicity exist in the District, and almost all residents who are uninsured or rely on public health coverage live in medically underserved areas. Residents report high rates of several chronic conditions, including hypertension, asthma, diabetes, and HIV/AIDS. 3 The District’s Medicaid program represents one of the largest health items in the city’s budget, and one of the areas in which prescription-drug spending can be tracked and addressed. The most recent data available indicate that the District’s Medicaid program dedicates much of its prescription-drug reimbursement spending to a few classes and groups of drugs: • The therapeutic categories accounting for the largest share of DC Medicaid spending between 1999 and 2004 were: o Anti-infective agents, 25% or more o Central nervous system drugs, 15 – 20% o Cardiovascular disease drugs, 14 – 17% • The drug groups accounting for the largest share of DC Medicaid spending between 1999 and 2004 also showed the highest rates of expenditure growth: o Antivirals, $9.9 million in 1999 and $24.9 million in 2004 o Antipsychotics, $4.5 million in 1999 and $16.1 million in 2004 Since Medicare became responsible for prescription-drug coverage of dual eligibles (those eligible for both Medicare and Medicaid) in 2006 under the new Medicare Part D prescription- drug benefit,
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